Objective: The objective of the study was to evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus caudal block for post-operative analgesia with levobupivacaine and dexamethasone as additive in extraperitoneal lower abdominal surgeries in pediatrics as there is no available literature showing the same. Methods: This is a randomized control study carried out between two groups among 50 children (1–8 years of age), both sexes, posted for elective extraperitoneal lower abdominal surgeries after taking informed consent from parents. Fifty children were randomly allocated into two groups, 25 in each group. Caudal epidural (CE) group received general anesthesia and caudal block with 1 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. TAP group received general anesthesia and ultrasound-guided TAP block with 0.5 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. Data were collected by means of pre-designed format with pre-/post-operative assessment with standardized scores. Results: The mean age of the patients was 4.84 (SD=2.29). Mean face, legs, activity, cry, and consolability score was low and non-significant before shifting the patient (<2 h post-operative [post-op]) in both the groups. Thereafter from 2 to 12 h, the mean score increased to 4.92 (SD=2.72) in the CE group and 2.92 (SD=2.17) in the TAP group and the difference was statistically significant at 2 h, 4 h, 6 h, and 12 h postoperatively. Mean time to rescue analgesia in the CE group was 4.96 h (SD=4.32) and 5.52 h (SD=7.53) in the TAP group and difference was statistically significant (p=0.000). Mean total rescue analgesic requirement for the CE and TAP groups was 298.40 mg (SD=170.70) and 111.40 mg (SD=138.81) and the difference was also significant. Post-operative complications such as urinary retention and motor blockade were seen in 28% of CE patients, while none of the patients experienced post-operative nausea/vomiting. Conclusions: Our study showed significant increase in duration of post-operative analgesia among TAP patients with reduced requirement of rescue analgesics and lesser post-operative complications as compared to CE patients

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS). Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi. Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free. Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.

Objective: The Objective of this study is to analyze the radiological, clinical and functional outcome of patients with acute unstable scaphoid fracture treated with primary bone grafting and K (Kirschner)-wire fixation Methods:Based on inclusion and exclusion criteria , a prospective observational study was carried out on 21 patients with acute unstable  scaphoid fracture who had been treated with primary bone grafting and K-wire fixation from November 2017 to March 2020 and were followed up for a minimum of 24 weeks. The average patient age was 26.9 years. The time from injury to treatment averaged 11days. Surgery was done under Bier’s Block using volar approach. Bone graft was harvested from distal Radius. The mean operating time was 24 minutes.Clinical parameters like tenderness, grip strength and Range of Movement (ROM) at wrist was assessed. The functional outcome was evaluated using Modified Mayo wrist score. Bone union was assessed using serial plain radiographs. Results:Union was achieved in all (100%) at 12 weeks. There was no evidence of Avascular necrosis (AVN) or arthrosis at latest follow up. As per Modified Mayo wrist score, there were 15 excellent,03 good and 03 fair results at the final follow-up. Individuals resumed their routine work at 12 weeks and all were comfortable with heavy works/ sports activity by 24 weeks. Conclusion: Primary bone grafting has a definite role in the management of acute unstable scaphoid fracture by which aquicker and higher rate of union isachieved with minimal complications. Open reduction allows thorough assessment of fracture for better anatomic reduction. Although the type of fixation device hardly contributes for quicker and higher union, but then the use of K-wire for fixation is the only viable option for smaller bony fragments and is more forgiving in terms of its positioning. It has an added advantage in terms of requirement of minimal inventory and thus is a cost-effective modality. This procedure also confirms that the patients could get back to their work earlier hence decreasing economic burden.